Deferred stenting (early or late) significantly reduced the incidence of no-reflow compared to immediate stenting (10% and 8% vs 24%, p=0.043) in STEMI patients with heavy thrombus burden.
RCT (n=150)
Open-label
Block Randomization
Sí
Does deferred stenting (early or late) reduce no-reflow and improve clinical outcomes compared to immediate stenting in STEMI patients with heavy thrombus burden?
In STEMI patients with heavy thrombus burden, deferring stenting (either 4-16 hours or 7 days) significantly reduces angiographic no-reflow and 6-month MACE compared to immediate stenting.
Tasa de eventos absoluta: 9% vs 24%
valor p: p=0.043
BACKGROUND: Deferred stenting, despite being successful in early studies, showed no benefit in recent trials. However, these trials were testing routine deferral; not in patients with heavy thrombus burden. RESULTS: This is a prospective, Randomized Clinical Trial that included 150 patients who presented with STEMI, patients were allocated into three equal groups after the coronary angiography ± primary intervention and before stenting of the culprit lesion; group (A) included 50 patients with early deferral of stenting, group (B) included 50 patients with late deferral and group (C) included 50 patients with immediate stenting. No-reflow was significantly higher in group C, while Final TIMI flow grade 3 and MBG grade 3 were significantly higher in group A and B than group C; p = 0.019 and < 0.001 respectively, with no significant difference between groups A and B, only the thrombus resolution in group B was significantly higher than group A; p < 0.001. Finally, 6-months, over-all MACE was significantly higher in group C (34.7% vs. 14.6% and 16.3%, p = 0.029). CONCLUSIONS: Stent deferral was proved to be better than immediate stenting after recanalization of IRA, in achieving TIMI III flow, reducing risk of 6 months MACE, and restoration of myocardial function in a subset of STEMI patients presenting with large thrombus burden. While, no significant difference was found between both deferral times in final TIMI flow, or clinical outcomes.
Magdy et al. (Thu,) conducted a rct in ST-segment elevation myocardial infarction (STEMI) with heavy thrombus burden (n=150). Deferred stenting (early 4-16 h or late 7 days) vs. Immediate stenting was evaluated on Incidence of no-reflow (p=0.043). Deferred stenting (early or late) significantly reduced the incidence of no-reflow compared to immediate stenting (10% and 8% vs 24%, p=0.043) in STEMI patients with heavy thrombus burden.